Provider Demographics
NPI:1174741102
Name:BOECKMANN, CHERI J (PT)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:J
Last Name:BOECKMANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 275
Mailing Address - Street 2:
Mailing Address - City:LOVINGSTON
Mailing Address - State:VA
Mailing Address - Zip Code:22949
Mailing Address - Country:US
Mailing Address - Phone:434-263-6200
Mailing Address - Fax:434-263-6202
Practice Address - Street 1:8445 THOMAS NELSON HWY.
Practice Address - Street 2:
Practice Address - City:LOVINGSTON
Practice Address - State:VA
Practice Address - Zip Code:22949
Practice Address - Country:US
Practice Address - Phone:434-263-6200
Practice Address - Fax:434-263-6202
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V739L16Medicare ID - Type UnspecifiedPT PROVIDER NUMBER
VAC08916Medicare ID - Type UnspecifiedCOMPANY PROVIDER NUMBER